Is Jared Loughner a 'White House Case'?

We don't yet know if Jared Lee Loughner was delusional when he went on a shooting rampage in Tucson. He's not talking, and no one has examined him and diagnosed him with anything that's been publicly revealed. But if he turns out to have been delusional -- and, more specifically, schizophrenic -- he would appear to have something in common with a type well known in the Washington area: the White House Case.

"White House Case" is the term of art used by psychiatrists since the at least the 1960s to describe a distinct subset of the mentally ill who become psychotically preoccupied with the inhabitants of the White House or other government offices.

The term originated at St. Elizabeth's Hospital in Southeast Washington, where members of the Secret Service would dump floridly delusional individuals from across the country and even the world who washed up at the White House gates, having incorporated the president into their distorted thinking as villain or savior.

The centrality of political figures in the deluded thinking of the psychotic is a problem Washington has been dealing with as long as there have been political figures and mentally ill -- and one it still grapples with today.

"Washington has a magnet effect," observed Robert Kiesling, the medical director of Pathways to Housing and a former medical director at St. Elizabeth's. "We get a lot of folks from all over the country -- all over the world for that matter -- who come here to do business with the government for various delusional reasons. They make up a high percentage of the homeless population in DC."

Most psychotic visitors drawn to the nation's capital by their political obsessions or delusions, according to a 1943 report by Dr. Jay L. Hoffman, who reviewed cases from 1927 to 1937, came seeking relief from a sense of persecution. A 1965 article from the American Journal of Psychiatry on "Psychotic Visitors to the White House" sought to follow up on Hoffman's contention that the personality of the president and current problems of the government influenced the type of person who showed up and the number of hospitalizations.

The study authors founds that this seemed to be the case, with the greater celebrity of President Kennedy leading to far more hospitalizations than were made in the final year of Eisenhower's presidency.

"In 1960, when Mr. Eisenhower was President, only nine patients were admitted, but 32 were hospitalized in 1961, Mr. Kennedy's inaugural year. This would suggest that some personal characteristic of the President was important," the authors concluded.

Delusional visitors to the White House or other government offices (often seeking a personal audience with the President) are interviewed by the Secret Service and then sent to Saint Elizabeths Hospital if they are considered mentally ill and potentially dangerous to themselves or others. A review of the demographic characteristics and diagnoses of 328 of these 'White House Cases' treated at the hospital between 1970 and mid-1974 showed that these patients were most commonly unmarried, white, and male, and most had a diagnosis of paranoid schizophrenia. Although 22% of this group have threatened some prominent political figure, to date none of this study's patients has attempted to assassinate any such government official.

But a 1990 survey on "Violent crime arrest rates of White House Case subjects and matched control subjects" came to a different conclusion, finding that in a sample of those "psychotically preoccupied with a prominent political figure" and discharged from psychiatric hospitals in the early 1970s, "White House Case subjects with prior arrests had a significantly higher rate of total posthospitalization violent crime arrests than the matched control sample."

Is the a lesson to be learned from Washington's experience with White House Cases in the wake of the Tucson shooting?

If so, it is a very straightforward one.

"The lessons from the shooting is the lessons from Virginia Tech and various other incidents that have happened like this," says Kiesling. "People need treatment and if they are experiencing symptoms, they need to get into treatment as soon as possible or they have bad outcomes."